Analgesia

Question 1

All pain is experienced in the _______

Answer 1

BRAIN

Question 2

Name the “five” classes of analgesics

Answer 2

NSAIDs
Opioids
Alpha-2 Agonists
NMDA-receptor antagonists
Local anesthetics

Bonus options

Question 3

Pros to opioids

Answer 3

Excellent analgesia
Relatively inexpensive
Minimal CV effects
Reversible w/ naloxone
Sedation

Question 4

Cons to opioids

Answer 4

Possible respiratory depression
GI upset
Histamine release (morphine!)
Parenteral primarily
Sedation
Abuse potential

Question 5

T/F: most of the time, GI effects are the limiting factor for opioid use.

Answer 5

True - has been shown to interfere with gut homeostasis and motility

Question 6

When are opioids a good choice?

Answer 6

Acute, severe pain

Not as good for chronic (beyond 24-48h) management

Question 7

Pros to NSAIDs

Answer 7

Excellent analgesia
Oral and parenteral formulations
Relatively inexpesive

Question 8

Cons to NSAIDs

Answer 8

Possible GI ulceration
Not reversible

Question 9

When are NSAIDs contraindicated?

Answer 9

Hypovolemia or dehydration

Question 10

Explain how NSAIDs effect the kidney

Answer 10

Prostaglandins mediate renal autoregulation (kidneys ability to maintain renal blood flow despite MA)

Blocking prostaglandins means kidneys cannot protect themselves

Question 11

When might NSAIDs be beneficial?

Answer 11

Severe, chronic, and/or orthopedic pain

Question 12

T/F: There is always the risk of GI upset/ulcers with NSAID administration, but it greatly varies between individuals

Answer 12

True - the lecture about how some people can take ibuprofen on an empty stomach but others can’t without puking their guts out

Question 13

Pros of alpha-2 agonists

Answer 13

Effective analgesia
Powerful sedation
Reversible w atipamezole

Question 14

Cons to alpha-2 agonists

Answer 14

Significant decrease in CO
Profound sedation
Respiratory depression
Parenteral only

Question 15

T/F: Administering a lower dose of alpha-2 agonists can help limit the drop in CO

Answer 15

False - regardless of the dose, administering an alpha-2 agonists results in 60-70% drop in CO

Question 16

Alpha-2 agonists should be limited to use in _______patients

Answer 16

Stable

Question 17

When are NMDA-receptor antagonists most useful?

Answer 17

Most effective if given before the painful stimulus

Preventing “wind-up”

Question 18

Pros of NMDA-receptor antagonists

Answer 18

Inexpensive
Oral and parenteral options
Good sedation
Minimal to no GI effects

Question 19

Cons to NMDA-receptor antagonists

Answer 19

Behavioral changes (usually not seen at analgesic doses)
Inconsistent analgesia
Best if used prior to painful stimulus
Muscle rigidity
Not reversible

Question 20

Ketamine works best in a __________analgesia approach

Answer 20

Multi-modal

Good w opioids

Question 21

Pros to local anesthetics

Answer 21

Regional anesthesia
Inexpensive

Question 22

Cons to local anesthetics

Answer 22

Not useful systemically as a solo agent
GI upset w/ systemic admin
Caution in cats
Relatively short-term effects with regional, unless repeat admin or catheter in place

Question 23

Name some (maybe) bonus analgesics

Answer 23

Gabapentin
Tramadol
Acetaminophen (not in kitties!)

Question 24

T/F: Tramadol is a powerful analgesic that is most effective in dogs

Answer 24

False - not powerful and more effective in cats